An Overview of Involuntary Holds in Rhode Island
The process of navigating an involuntary psychiatric hold can be confusing and emotionally intense for both patients and their loved ones. Questions surrounding legal rights, treatment methods, and the duration of the hold are common and perfectly understandable. Gaining a basic understanding of the procedure, rights, and available resources is essential for ensuring proper care during this difficult time.
What Happens During an Involuntary Hold?
In the U.S., psychiatric holds, also known as involuntary commitments, are procedures that allow an individual to be temporarily detained in a mental health institution if they are considered a risk to themselves or others, or are too mentally unfit to care for themselves. These holds are governed by state-specific laws and are usually initiated by healthcare professionals, law enforcement, or concerned loved ones. During this hold, the person is evaluated by mental health professionals. If further care is needed, a court hearing may follow to determine if a longer treatment plan is necessary. If the patient does not meet the criteria for extended involuntary treatment, they may be released, often with recommendations for outpatient care or therapy.
When Are Holds Necessary?
They are at risk of harming themselves (e.g., suicidal actions)
They pose a threat to others (e.g,. violent behavior, threats)
They are unable to care for themselves due to severe mental illness (e.g., not eating or bathing)
Involuntary Holds in Rhode Island
In Rhode Island, laws surrounding involuntary psychiatric holds are outlined in Title 40.1, Chapter 5 of Rhode Island General Laws. A short-term emergency detention ordered due to a mental health crisis typically lasts up to 72 hours for observation and evaluation at a mental health facility. According to Rhode Island law, this initial hold can be authorized by mental health professionals, law enforcement, or even family members, depending on the situation. If, after an evaluation, the patient is deemed to require further care, a court hearing is scheduled to determine if longer-term commitment is necessary.
Types of Involuntary Holds in Rhode Island
§ 40.1-5-7 (emergency evaluation)
Primary purpose is to stabilize and assess patients experiencing a mental health crisis, ensuring the immediate safety of themselves and others.
These can be initiated by a police officer, mental health professional, or private citizen, such as a family member or friend. This process often involves taking the individual to an emergency room for evaluation.
Usually lasts for a shorter period, generally 72 hours maximum, allowing professionals such as an APRN (advanced practice registered nurse) to determine the need for further intervention. Emergency holds may extend up to 30 days if there are no suitable alternatives. However, they may not exceed 30 days without a court order.
Requires the individual to be deemed a danger to themselves or others, which can include being gravely disabled. In Rhode Island, direct observations of this behavior must have occurred within a 10-day period of filing a petition.
§ 40.1-5-7.1 (taking into protective custody)
Primary purpose is to provide longer-term treatment to those with mental illness who are deemed unable to make rational decisions about their care or who pose a risk to themselves or others.
Can be initiated by a court order after an initial emergency hold or through a separate legal process with a petition to the probate court.
Probate courts oversee guardianship of minors and adults unable to make logical legal or financial decisions on their own, including due to mental illness.
Can be for a specific period (e.g., several months) or until the individual no longer meets the criteria for commitment. Court orders may extend the hold by 90 days if it is deemed necessary.
Requires the probate court to find that the individual has a mental illness, is gravely disabled, or poses a threat to themselves or others.
Alternative Options
In Rhode Island, alternatives to inpatient treatment may be considered before or during the process, such as intensive outpatient treatment or placement with a relative.
Potential Outcomes
Release: After the initial hold, the individual may be released if no further risk is deemed present.
Extended commitment: If a court finds that the person remains a danger, they may be placed under longer-term involuntary commitment.
Outpatient treatment: The individual may be discharged with recommendations for follow-up therapy, counseling, and/or medication.
Know Your Rights
Rights of the Individual
Right to be informed: The patient must be informed of the reason for the hold.
Right to a lawyer: The individual has the right to legal representation and can challenge the hold in court.
Right to a hearing: If the hold lasts beyond 72 hours, the person is entitled to a court hearing to determine if continued involuntary treatment is necessary.
Right to refuse medication: The person may refuse medication unless a court order or emergency situation justifies otherwise.
Right to confidentiality: Medical information is protected under HIPAA, though some disclosures may be made for safety reasons.
Rights of the Family & Caregivers
Right to provide information: You can share relevant medical history, symptoms of mental health crises, and prior treatments to assist with evaluation.
Right to request information: While you may not have direct access to the patient’s medical information, you may be able to request updates or a meeting with the care team.
Right to an advocate: You can request legal advice or a patient advocate if you are concerned about the process or treatment.
Right to help with discharge planning: If the hold is lifted, family can help with transitioning to outpatient care, therapy, or other support services.
How You Can Help
Stay informed and involved: Understand the legal process and stay in touch with the treatment team.
Provide emotional support: Offer reassurance and understanding to the individual. Empathize with them by acknowledging that the process can feel overwhelming.
Ensure aftercare: Once the hold ends, ensure the patient receives necessary follow-up care to prevent future crises.
Know your resources: Familiarize yourself with mental health advocacy groups, such as the Mental Health Association of Rhode Island (MHARI) for additional support.
Conclusion
Navigating an involuntary psychiatric hold can be a challenging and emotionally taxing experience for individuals and their families. However, understanding the rights of those involved and the available legal processes can help ensure that the person receives the care they need while respecting their rights. Whether it’s through providing essential information, seeking legal advice, or helping with aftercare, families and loved ones play a crucial role in supporting recovery. By staying informed and involved, you can help make the process smoother and ensure that the individual receives the proper treatment and support during and after the hold.
